PROJECT SUMMARY Beginning in 2012, the State of Oregon explicitly identified ?Health Equity and Eliminating Health Disparities? as a key target of its Medicaid reform. Given the large share of transgender persons covered by the Medicaid program, changes in Medicaid policy provide a unique opportunity to address health and health disparities for this gender minority group. Recent cross-sectional studies suggest public insurance significantly improves access to transition-related care for transgender adults, while also increasing usage of preventive care and medically necessary services, resulting in better health outcomes for this population. In January 2015, Oregon extended its Medicaid benefits to provide coverage for transition-related care for transgender persons in order to address mental health disparities in this community. In doing so, Oregon became the second state whose Medicaid policy explicitly covered healthcare related to gender transition for transgender persons. As of March 2018, eighteen states and the District of Columbia now have similar Medicaid policies, but none have studied the impact of the new policy. Using extensive Oregon Medicaid claims data from 2010-2017, and applying a validated algorithm developed by the Centers for Medicare & Medicaid Services for identifying transgender persons in administrative claims, this proposal aims undertake an analysis of longitudinal data to assess the ways in which health and health disparities in the transgender community can be improved by Medicaid reform, while also describing whether coverage for transition-related care meaningfully impacts use of these services by transgender beneficiaries.